Noninfectious Inflammation After Intravitreal Injection of Aflibercept: Clinical Characteristics and Visual Outcomes
Noninfectious Inflammation After Intravitreal Injection of Aflibercept: Clinical Characteristics and Visual Outcomes
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DOI：
10.1016/j.ajo.2014.06.019
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发表时间：
2014-10-01
影响因子：
4.2
通讯作者：
Heier, Jeffrey S.
中科院分区：
文献类型：
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作者：
Goldberg, Roger A.;Shah, Chirag P.;Heier, Jeffrey S.
目的：报告一系列玻璃体腔注射阿柏西普后出现非感染性炎症的患者的临床特征和临床结果。设计：非比较连续病例系列。方法：回顾性分析2011年11月18日至2013年6月30日期间玻璃体腔注射阿柏西普后出现非感染性炎症的患者的医疗记录。结果：共有20例注射后炎症患者被纳入研究。在 5356 支阿柏西普注射液中发现。患者在注射阿柏西普后 1-13 天就诊（中位 3 天）；所有人都注意到视力下降，20 人中有 3 人（15%）有疼痛，20 人中有 2 人（10%）有结膜充血。一名患者出现前房积脓 (0.5 mm)，平均前房细胞数为 1.8+（范围 0 至 4+）。所有眼睛都有一定程度的玻璃体炎（平均 1.8+；范围 0.5+ 至 4+）。患者之前平均接受过 6 次阿柏西普注射（范围 0-16）。在该系列中，只有 1 名首先出现炎症的患者接受了玻璃体内穿刺（培养阴性）和抗生素注射。所有患者均接受频繁的局部类固醇治疗，并密切随访是否有改善迹象。除 1 名患者外，所有患者均恢复了注射前视力（平均：33 天；范围：7-73 天）。随后，4 名患者再次接受阿柏西普注射，其中 1 名患者在额外注射 5 次阿柏西普后再次出现炎症。玻璃体内注射阿柏西普后炎症的总体发生率为 5356 次注射中的 20 例（0.37%）或 844 例患者中的 19 例（2.25%）。然而，不成比例的病例集中在 1 个提供者周围（17/20，85%；与所有其他提供者相比，P < .001）以及该医生主要工作的 2 个办公地点周围（16/20，75%；与 5 个其他办公室相比，P < .001）。结论：玻璃体内阿柏西普注射后的非感染性炎症通常不会出现疼痛、结膜充血或前房积脓，并且对局部类固醇治疗有反应。视力结果通常是有利的，但恢复到基线视力可能需要数周时间。 (C) 2014 年，Elsevier Inc. 保留所有权利。
PURPOSE: To report the presenting features and clinical outcomes of a series of patients with noninfectious inflammation after intravitreal aflibercept injection.DESIGN: Noncomparative consecutive case series.METHODS: Medical records of patients who presented with noninfectious inflammation after intravitreal aflibercept injection between November 18, 2011 and June 30, 2013 were retrospectively reviewed.RESULTS: A total of 20 cases of postinjection inflammation were identified in 5356 aflibercept injections. The patients presented 1-13 days after aflibercept injection (median 3 days); all noted decreased vision, while 3 of 20 (15%) had pain and 2 of 20 (10%) had conjunctival injection. One patient had a hypopyon (0.5 mm), and the average anterior chamber cell was 1.8+ (range 0 to 4+). All eyes had some degree of vitritis (average 1.8+; range 0.5+ to 4+). Patients on average had received 6 prior aflibercept injections (range 0-16). Only 1 patient the first to present with inflammation in this series received an intravitreal tap (culture negative) and injection of antibiotics. All patients were managed with frequent topical steroids and were followed closely for signs of improvement. All but 1 patient regained their preinjection visual acuity (average: 33 days; range: 7-73 days). Four patients were subsequently rechallenged with aflibercept, and 1 developed inflammation again after 5 additional aflibercept injections. The overall incidence of inflammation after intravitreal aflibercept injection was 20 of 5356 injections (0.37%) or 19 of 844 patients (2.25%). However, a disproportionate number of cases clustered around 1 provider (17/20, 85%; P < .001 vs all other providers) and around the 2 office locations where this physician primarily worked (16/20, 75%; P < .001 vs 5 other offices).CONCLUSIONS: Noninfectious inflammation after intravitreal aflibercept injection typically presents without pain, conjunctival injection, or hypopyon, and responds to topical steroid therapy. The visual outcomes are generally favorable, though the return to baseline acuity can take many weeks. (C) 2014 by Elsevier Inc. All rights reserved.